Esophageal cancer is a prevalent malignant tumor of the digestive tract in China, and radical surgery remains the cornerstone of its comprehensive treatment. However, multifactorial challenges such as postoperative gastrointestinal tract reconstruction, traumatic stress, and tumor-related metabolic disturbances render esophageal cancer patients highly susceptible to malnutrition. Perioperative nutritional support therapy plays a crucial role in enhancing surgical safety, improving clinical outcomes, and elevating patients' quality of life by regulating metabolic homeostasis, preserving organ function, and optimizing the immune microenvironment. This article reviews the mechanisms underlying malnutrition in esophageal cancer, methods for nutritional status assessment, and precision intervention pathways based on multi-omics evaluations. The aim is to strengthen clinicians' awareness of standardized perioperative nutritional management for esophageal cancer patients and promote its clinical implementation, thereby facilitating postoperative recovery and improving long-term quality of life.

[Objective] To extract hemoglobin (Hb) from red blood cells using osmotic pressure swelling method, expected to achieve a hemoglobin dissolution rate of ≥80% and a cell membrane integrity rate of ≥70%. [Methods] Human umbilical cord blood red blood cells were used as raw materials and phosphate buffer solution was used as the swelling solution for red blood cells. A three factor three-level orthogonal experiment (n=3) was conducted to determine the optimal matching conditions for selecting the osmolality molar concentration of phosphate buffer solution, pH value of hypotonic phosphate buffer solution and volume ratio of hypotonic phosphate buffer solution to washed red blood cells. Red blood cell swelling solution samples (n=6) were prepared by the optimal matching conditions and the original process conditions. The hemoglobin dissolution rate and cell membrane integrity rate were checked. In the expanded comparative experiment, red blood cell swelling solution samples (n=6) were prepared by the optimal matching conditions and the original process conditions, which was filtered by ultrafiltration membranes. The filtration time and hemoglobin yield were checked. [Results] The optimal matching conditions for preparing red blood cell swelling solution were obtained through orthogonal experiment as follows: osmotic pressure molar concentration was 30 mOsmol/Kg, pH was 7.8, and phosphate buffer to red blood cell volume ratio was 6∶1. On the basis of the above conditions, the red blood cell swelling solution sample was compared with the original process sample: the hemoglobin dissolution rate was (82.4±1.8)% vs (78.6±3.0)% (P<0.05), and the cell membrane integrity rate was (65.8±4.0)% vs (28.7±2.3)% (P<0.05). In the expanded comparative experiment, the optimal matching conditions were compared with the original process conditions: filtration time(s) (327±9) vs (434±13) (P<0.05), and hemoglobin yield was (72.3±1.2)% vs (66.0±1.4)% (P<0.05). [Conclusion] Compared with the original preparation process, the hemoglobin extraction process which optimized through orthogonal experiments greatly reduces the cell membrane fragmentation rate and minimizes the entry of cell membrane matrix into the target solution, ensuring a slightly higher hemoglobin dissolution rate, and reducing the preparation difficulty for the subsequent cell membrane separation and further purification.

Objective:To explore the predictive value of serum Dickkopf-related protein 1 (DKK1) and chemokine 21 (CCL21) expression for the pulmonary fibrosis progression in patients with rheumatoid arthritis associated interstitial lung disease (RA-ILD).Methods:A prospective study method was used. One hundred and eight patients with RA-ILD (RA-ILD group) and 108 patients with simple rheumatoid arthritis (RA group) from September 2020 to July 2023 in Jincheng People's Hospital were selected. The patients with RA-ILD were treated with disease-modifying antirheumatic drugs and anti fibrotic drugs. Before treatment, the serum DKK1, CCL21, C-reactive protein (CRP), anti cyclic citrullinated peptide antibody (ACPA), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR) salivary liquefied glycan antigen 6 (KL-6) were detected; the 28 joints disease activity score (DAS28) and Warrick score were assessed. The patients with RA-ILD were followed up for 1 year, and the occurrence of pulmonary fibrosis progression was recorded. The patients with pulmonary fibrosis progression were included in the progressive subgroup and vice versa in the stable subgroup. Multivariate Logistic regression was used to analyze the independent risk factors for predicting pulmonary fibrosis progression within 1 year in patients with RA-ILD. The predictive value of serum DKK1 and CCL21 for predicting the pulmonary fibrosis progression within 1 year in patients with RA-ILD was analyzed by receiver operating characteristic (ROC) curve. The decision curve of serum DKK1 and CCL21 to predict the pulmonary fibrosis progression within 1 year in patients with RA-ILD was plotted using the R language package.Results:The DKK1 in RA-ILD group was significantly lower than that in RA group: (76.02 ± 9.80) ng/L vs. (86.44 ± 9.26) ng/L, the CCL21 was significantly higher than that in RA group: (202.02 ± 25.86) ng/L vs. (172.42 ± 18.35) ng/L, and there were statistical differences ( P<0.01). The patients with RA-ILD were followed up for 1 year, 25 cases (23.15%) developed pulmonary fibrosis progression (progressive subgroup), and 83 cases did not develop pulmonary fibrosis progression (stable subgroup). The Warrick score, CCL21, ACPA and KL-6 in progressive subgroup were significantly higher than those in stable subgroup: (11.80 ± 3.56) scores vs. (7.75 ± 1.81) scores, (224.53 ± 27.26) ng/L vs. (195.25 ± 21.32) ng/L, (452.46 ± 38.35) kU/L vs. (414.37 ± 31.63) kU/L and (466.35 ± 42.32) kU/L vs. (416.82 ± 38.34) kU/L, the DKK1 was significantly lower than that in stable subgroup: (68.65 ± 8.24) ng/L vs. (78.24 ± 9.15) ng/L, and there were statistical differences ( P<0.01); there were no statistical differences in DAS28, RF, ERS and CRP between the two subgroups ( P>0.05). Multivariate Logistic regression analysis result showed that Warrick score, DKK1, CCL21, ACPA and KL-6 were independent risk factors for predicting pulmonary fibrosis progression within 1 year in patients with RA-ILD ( OR = 2.601, 0.752, 1.110, 1.062 and 1.038; 95% CI 1.227 to 5.517, 0.578 to 0.978, 1.019 to 1.209, 1.009 to 1.118 and 1.001 to 1.076; P<0.05). The ROC curve analysis result showed that the area under the curve of DKK1 and CCL21 for predicting pulmonary fibrosis progression within 1 year in patients with RA-ILD was 0.779 and 0.795, with optimal cutoff values of 74.750 and 207.615 ng/L. The area under the curve of DKK1 combined with CCL21 for predicting pulmonary fibrosis progression within 1 year in patients with RA-ILD was 0.873. The decision curve analysis result showed that the DKK1 combined with CCL21 for predicting pulmonary fibrosis progression within 1 year could improve the predictive value (the maximum benefit rate was 23.15%). Conclusions:Compared with RA patients, RA-ILD patients have decreased serum DKK1 levels and increased CCL21 levels. In patients with RA-ILD, the low expression of DKK1 and high expression of CCL21 are the risk factors of pulmonary fibrosis progression, and detecting serum levels of DKK1 and CCL21 can predict the risk of pulmonary fibrosis progression.

Objective·To evaluate the feasibility and diagnostic performance of diffusion-relaxation correlation spectroscopic imaging(DR-CSI)in assessing the heterogeneity of benign and malignant head and neck tumors,as well as in identifying occult lymph node metastasis(OLNM).Methods·A prospective study was conducted from January to December 2024 at Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,enrolling patients with suspected head and neck tumors who were scheduled for surgery and had a confirmed pathological diagnosis.All patients underwent preoperative routine head and neck plain and contrast-enhanced magnetic resonance imaging(MRI)examinations,including DR-CSI sequence.Conventional imaging parameters,including maximal diameter(MD),depth of invasion(DOI)for tumors,and MD and short diameter(SD)for lymph nodes,were obtained.Post-processing was performed to obtain apparent diffusion coefficient(ADC),T2 value,and D-T2 spectra for all lesions.The compartment segmentation strategy was optimized based on the spectral peak distribution characteristics of different diseases,and the volume fraction(Vi)of each compartment was obtained.Independent sample t-tests,Mann-Whitney U tests,chi-square tests,or Fisher's exact tests were used to compare intergroup differences in clinical data and imaging metrics.Principal component analysis(PCA)and Adonis analysis were employed to evaluate the discriminative ability of imaging metrics among different subtypes of benign tumors.Receiver operating characteristic(ROC)analysis was used to evaluate the ability of univariate and multivariable models to characterize the malignancy of head and neck squamous cell carcinoma(HNSCC)and identify OLNM.Results·A total of 97 cases were collected,including 28 benign tumors and 69 HNSCCs.Fifteen pathologically confirmed OLNMs and 20 benign lymph nodes(BLNs)were also enrolled.Among the 28 benign tumors,there were 6 cases of pleomorphic adenoma stroma-rich(PA stroma-rich),9 cases of pleomorphic adenoma stroma-poor(PA stroma-poor),9 cases of Warthin's tumor(WT),and 4 cases of basal cell adenoma(BCA).Statistically significant differences were observed in certain imaging parameters(ADC,T2,and DR-CSI Vi)among benign tumor subtypes.PCA analysis demonstrated a strong discriminative ability of imaging parameters in distinguishing pathological subtypes of benign tumors(R2=0.64,P<0.001).Among the 69 HNSCCs,47 were classified as Grade 1(well/moderately well-differentiated)and 22 as Grade 2(moderately/poorly differentiated).Compared to Grade 1,Grade 2 showed lower ADC and higher T2 values,though differences were not statistically significant.As HNSCC malignancy increased,VA4 decreased and VB4 increased significantly.OLNM showed a significant increase in SD and VA4 compared to BLNs.The combination of SD and VA4 for preoperative OLNM identification achieved a diagnostic efficiency of 0.843.Conclusion·DR-CSI can analyze diffusion and relaxation characteristics at the sub-voxel level,offering valuable insights for characterizing benign head and neck tumor subtypes,assessing HNSCC malignancy,and identifying OLNMs.Compared to traditional parameters like ADC or T2,DR-CSI provides enhanced tissue microstructure analysis.

Objective To differentiate disguised visual acuity,(VA)by analyzing discrepancies across diversified visual acuity tests.Methods Volunteers were recruited,and VA(V,and V2)was measured before and after the experiment.Volunteers independently selected an experimental VA(Vt)and were assigned to either the disguised group or the control group.A specially designed heterogeneous optotype chart and a single-optotype chart with variable test distances were used to measure VA(t1,t2,t3),while a standard logarithmic VA chart was used to measure VA(t4).Based on the maximum VA discrepancy(△t),t4 was classified as"real"(≤ 1 line),"disguised"(≥ 2 lines),or"suspicious"(＞1 and＜2 lines with anomaly).Results A total of 126 valid cases were collected,including 30 in the control group and 96 in the disguised group,with VA ranging from 0.2～1.5.All 88 opinions classified as"disguised"were from the disguised group,and all 29 classified as"real"were from the control group.Of the 7 cases deemed"suspicious,"6 were from the disguised group.The sensitivity,specificity,and overall diagnostic accuracy were 91.7％,96.7％(P＜0.0001),and 92.9％(P＜0.0001),respectively.In the disguised group,38 cases exhibited unexplained identifying anomalies.Conclusion A VA discrepancy of ≥ 2 lines is a reliable indicator for detecting disguised visual acuity.Identifying anomalies may serve as a novel and sensitive marker for recognizing visual disguise.

Objective:To understand the status of human resources allocation of non-profit pension institutions in representative cities of our country, analyze the existing problems and put forward countermeasures and suggestions, in order to provide reference for improving the service quality of non-profit pension institutions in cities.Methods:From October to December 2020, 5 sub-provincial capitals and 1 municipality directly under the central regions were selected by random sampling in Northeast, Northwest, Southeast, Southwest and Central Plains, and 60 non-profit pension institutions were selected as research objects by purpose sampling, and a questionnaire survey was conducted on the human resources allocation of pension institutions.Results:Among the elderly care institutions investigated, 48 were registered medical and nursing care institutions. There were 25 elderly care institutions with medical beds, accounting for 41.7%(25/60); there were 39 nursing institutions with doctors, accounting for 65.0%(39/60); there were 53 nursing institutions with nurses, accounting for 88.3%(53/60); from the perspective of relative indicators, the number of medical staff per bed in 60 nursing institutions was 0.12, and the number of medical staff per bed in medical nursing institutions was 0.14.Conclusions:The personnel allocation of non-profit elderly care institutions is not reasonable, and there is a lack of professional multidisciplinary professional teams to provide elderly care services. The personnel allocation and demand of non-profit pension institutions do not match, and the supply and application of human resources are unbalanced. Non-profit pension institutions should continue to promote the combined development of medical and nursing care to meet the diversified needs of elderly people in pension institutions. It is suggested that relevant departments jointly formulate the human resources allocation standards for elderly care institutions, and strengthen the practice access, grading and assessment of medical and nursing professionals.

Objective:To explore the effectiveness of rapid cycle deliberate practice (RCDP) in training newly hired nurses′comprehensive emergency competence and to provide references for enhancing their capabilities.Methods:A quasi-experimental study was conducted using purposeful sampling. From September to December 2022, newly hired nurses at Liaocheng Second People′s Hospital were selected as research subjects and randomly assigned to a controlor an observation group using random number table. The control group received traditional group drill training, while the observation group underwent RCDP training. The study compared pre- and post-training scores of emergency theory and skill assessments, scores on the Chinese version of the Perceived Cognitive Ability Scale in Emergency Situations (PCAS), and training satisfaction levels between the two groups.Results:Each group comprised 30 nurses. The control group consisted of 3 males and 27 females, with a mean age of (22.70 ± 1.09) years; the observation group included 2 males and 28 females, with a mean age of (22.93 ± 0.87) years. Post-training comprehensive emergency competence assessment scores was (89.19 ± 1.47) in the control group and (93.00 ± 1.41) in the observation group, with a statistically significant difference ( t = - 4.60, P<0.01). The scores and total scores of PCAS in the observation group were (34.23 ± 1.91), (12.70 ± 1.62), (10.03 ± 1.52) and (56.97 ± 3.09), respectively, which were higher than the (31.70 ± 2.42), (11.90 ± 1.16), (9.10 ± 1.42), and (52.47 ± 3.65) in the control group, the difference between the two groups were statistically significant ( t value were - 5.16 - - 2.20, all P<0.05). The total score of training satisfaction of nurses in the observation group was (41.93 ± 2.53) points, and the difference was statistically significant compared with the (33.80 ± 2.58) pointsin the control group ( t = - 12.33, P<0.01). Conclusions:The application of the RCDP method in training newly recruited nurses′comprehensive emergency competence effectively enhances their learning enthusiasm and initiative, thereby improving training outcomes.

Acute respiratory distress syndrome(ARDS)is a common respiratory emergency,but current clinical treatment remains at the level of symptomatic support and there is a lack of effective targeted treatment measures.Our previous study confirmed that inhalation of hydrogen gas can reduce the acute lung injury of ARDS,but the application of hydrogen has flammable and explosive safety concerns.Drinking hydrogen-rich liquid or inhaling hydrogen gas has been shown to play an important role in scavenging reactive oxygen species and maintaining mitochondrial quality control balance,thus improving ARDS in patients and animal models.Coral calcium hydrogenation(CCH)is a new solid molecular hydrogen carrier prepared from coral calcium(CC).Whether and how CCH affects acute lung injury in ARDS re-mains unstudied.In this study,we observed the therapeutic effect of CCH on lipopolysaccharide(LPS)induced acute lung injury in ARDS mice.The survival rate of mice treated with CCH and hydrogen inhalation was found to be comparable,demonstrating a significant improvement compared to the untreated ARDS model group.CCH treatment significantly reduced pulmonary hemorrhage and edema,and improved pulmonary function and local microcirculation in ARDS mice.CCH promoted mitochon-drial peripheral division in the early course of ARDS by activating mitochondrial thioredoxin 2(Trx2),improved lung mitochondrial dysfunction induced by LPS,and reduced oxidative stress damage.The results indicate that CCH is a highly efficient hydrogen-rich agent that can attenuate acute lung injury of ARDS by improving the mitochondrial function through Trx2 activation.

Objective:To investigate the policy impacts of the Beijing-Tianjin-Hebei coordinated development strategy on medical and health resources in Beijing,Tianjin,and Hebei.It also seeks to analyze these effects comprehensively and provide recommendations.Methods:Relevant data on medical and health resources from 2005 to 2022 across all 31 provinces,municipalities,and autonomous regions were summarized.The entropy weight method was used to construct the comprehensive index,allocation index and utilization index of Beijing-Tianjin-Hebei healthcare resources as important indicators for evaluating the policy effects,and the regression control method was used to analyze the policy effects of Beijing-Tianjin-Hebei healthcare integration on the healthcare resources in Beijing,Tianjin and Hebei.Results:The coordinated development strategy has produced varying policy effects on medical and health resources in these three locations,with more pronounced effects observed in Beijing and Hebei compared to Tianjin;however,a comprehensive breakthrough towards promoting efficient utilization of regional medical and health resources has not yet been achieved.Conclusion:On the basis of further optimizing the allocation of resources,it is needed to enhance the efficiency of resource utilization,while identifying the positioning of synergistic development of Beijing,Tianjin and Hebei to further enhance the effect of health policies

Objective To explore the effect of playing moderate-intensity table tennis and badminton on myo-pia prevention among children between 7 and 9 years old,so as to provide related theoretical basis.Methods A total of 536 myopic children were initially screened from two schools in Guangzhou via questionnaires and in-terviews.Among them,36 children(7-9 years old)were selected and randomly divided into a control group,a table tennis group and a badminton group,each of 12.All groups underwent 1.5-hour training three times a week for six months,covering training on dynamic visual acuity,sports vision and attention training and the ex-ercise intensity was adjusted according the heart rate,rating of perceived exertion(RPE)and blood oxygen lev-els.Moreover,the equivalent spherical degree(SED),ocular biology,and accommodative parameters were mea-sured before and after the intervention.Results After intervention,the left eye SEDs of the control and badmin-ton groups were lower than before intervention(P<0.05).Moreover,the axial length(AL)in the left and right eyes and the axial length/corneal radius of curvature(AL/CR)of all 3 groups after intervention were significant-ly higher than before that(P<0.05).The table tennis group showed significant improvement in accommodative fa-cility(AF)in both eyes(P<0.05),while the badminton group demonstrated significant increases in AF of both eyes,amplitude of accommodation(AMP)in the right eye,but a significant decrease in the positive relative adjustment(PRA)(P<0.05).Moreover,after intervention,SE and AF of both eyes in the table tennis group was significantly higher,with lower AL and AL/CR ratios in the left eye compared to the control group(P<0.05).The badminton group exhibited greater AMP in the right eye and AF improvements in both eyes com-pared to the control and table tennis groups(P<0.05),but lower PRA(P<0.05).Moreover,the left-eye SE of the badminton group was higher than the control group(P<0.05),while the right-eye corneal curvature and the left-eye AL/CR were lower than the latter(P<0.05).Meanwhile,after the intervention,the left-eye AL and PRA of the badminton group were significantly lower than the table tennis group(P<0.05).Conclusion Pupils can effectively increase their reserve of eye adjustment,improve the adjustment function of the eye,and delay the development of myopia by playing table tennis and badminton with moderate intensity.Playing table tennis excels in delaying refractive power changes,while doing badminton significantly improves PRA,AMP,and AF.